Nasal/Sinus Formula: Relief from Allergies and Congestion

Ingredients:

Chai hu – Bupleurum chinense root

Huang qin – Scutellaria baicalensis root

Ban xia – Pinellia ternate rhizome (treated)

Sheng jiang – Zingiber officinale root (fresh)

Da zao – Zisiphus jujuba fruit

Xin yi hua – Magnolia liliflora bud

Cang er zi – Xanthium sibiricum fruit

Bai zhi – Angelica dahurica root

Shi chang pu – Acorus gramineus rhizome

Jie geng – Platycodon grandiflorum root

Ju hua – Chrysanthemum morifolium flower

Ge gen – Pueraria lobata root

Sheng gan cao – Glycyrrhiza uralensis root

Pu gong ying – Taraxacum officinale root and leaf (tinctured fresh)

Water

Ethanol

Honey

Effects:

Reduce or eliminate symptoms of seasonal allergies, especially runny or stuffed nose.  Resolve long-lasting cold whose main residual symptom is stuffy nose and blocked sinus.

Dosage:

Standard dose is four full squirts of the dropper, twice a day.  For some people the standard dose is overly drying; if you find this is the case for you, try a smaller dose until you hit upon the right dose for you.  If you predictably suffer from seasonal allergies, combine with Jade Defense and begin this regimen a month or so ahead of your allergy season – three squirts Jade Defense and one squirt Nasal/Sinus Formula, twice a day.  For snotty colds and sinus infections, combine with Virus Killer (forthcoming from Green Monkey Pharmacy).  The best way to take this formula is to squirt the tincture directly into your mouth and hold it in your mouth for maximum buccal absorption so that some of the anti-allergy components in the herbs can directly enter the affected tissues of the face, bypassing the general circulation.  This is one formula that I don't recommend thinning down in boiled water; you don't want to boil off the volatile components that give it much of its anti-allergy power.

Product Description:

This formula is built on Xiao Chai Hu Tang (“Minor Bupleurum Decoction”) from the Shang Han Lun or “Treatise on Cold Damage,” one of the earliest (220 CE) and most famous books of Chinese medicine.  The original formula was designed to treat the shaoyang or “lesser yang” stage of a disease, when a pathogen has neither completely penetrated the body’s defenses nor been successfully fended off.  This “not in, not out” status describes allergies and unresolved colds, making this an ideal formula for treating both.

The original formula consists of chai hu (bupleurum), huang qin (scutellaria), ban xia (pinellia), sheng jiang (fresh ginger), ren shen (ginseng root), da zao (jujube date) and zhi gan cao (cured licorice root).  In my version I substitute dang shen (codonopsis) for ginseng and uncured licorice for cured licorice, and add a number of other herbs to make the formula more effective for nasal and sinus symptoms.  Xiao Chai Hu Tang is an energetically very interesting formula.  The main herb, chai hu, is cool and outthrusting, making it effective for clearing a pathogen (whether virus or pollen) from the in-between zone where it resides.  Chai hu also moves stagnant qi, making it a good herb for soothing the out-of-sorts feeling that an allergy or head cold can produce.  Huang qin is a major heat-clearing and dampness-drying herb that pairs nicely with chai hu to vent the pathogen in a shaoyang-type disorder.  Huang qin also pairs well with ban xia, which is one of the major herbs for treating phlegm of all types.  Interestingly, in light of its inclusion in this allergy formula, recent research shows that one of the major components of huang qin, known as baicalein, inhibits mast cells and therefore minimizes histamine release and allergy symptoms.  The remaining herbs in the original formula – sheng jiang, ren shen/dang shen, da zao, and sheng gan cao – strengthen the qi to help keep the pathogen from penetrating further.  The da zao and sheng gan cao also serve to balance the drying nature of ban xia and some of the other herbs that I add to the original formula.

Since this is a remedy for allergies and lingering colds with predominantly nasal symptoms such as stuffiness and runny nose, I have added additional herbs for this purpose.  Xin yi hua (magnolia bud), cang er zi (cocklebur), and bai zhi (angelica dahurica root) are the trinity typically employed for this purpose, to which I add shi chang pu (acorus rhizome).  Shi chang pu is traditionally used to “open the portals” of the sensory organs in heavy-duty conditions like seizures and disorientation.  In larger doses it is mildly psychoactive; in our smaller dose it serves as one more opener of the nose and sinuses.  Next year I will add silver beach bur, the local coastal ragweed, which like its other ragweed cousins is excellent for treating the very allergies its copious pollens produce in many people (as of today it hasn’t flowered yet, and I prefer the idea of using the flowering plant rather than just the foliage).

Finally, ju hua (chrysanthemum), jie geng (platycodon), ge gen (kudzu root), and fresh tincture of dandelion were added.  Ju hua addresses the itchy and dry eyes that accompany many allergies.  Jie geng together with the licorice directs the formula to the throat region, which is often itchy and irritated.  Ge gen directs the formula to the regions of the nose and sinuses, and, together with sheng gan cao and da zao, helps to offset the drying nature of the formula.  Pu gong ying (dandelion) is added not because it is an anti-allergy herb per se (although, together with the ju hua and huang qin, it is useful for hot red itchy eyes), but because it is a premier liver herb and spring is the season of the liver so it supports this organ during the season that it is most stressed.  I am not as gung ho about “detoxifying” as many in the alternative medicine community, but in this context of seasonal allergies I do believe that it is useful to add a detoxifying herb like dandelion to the mix, to make the formula work better.

Production Notes:

3.75 liters of an alcohol-water blend was slowly percolated through 1.25 kilogram of pre-moistened ground-up herbs to produce about 3 liters of tincture.  200 ml of dandelion fresh tincture was added directly to the resulting tincture.  Strength of the final tincture is about 1:2.5. 

Something Else You Can Do to Treat Allergies and Stuffy Nose:

When they find out that you suffer from allergies, about 95% of people in Santa Cruz will immediately tell you to use a neti pot.  For the small minority of readers who are unfamiliar with the neti pot, it is essentially a small pitcher designed to pour warm salt water through your nostrils to flush out your nasal passages.  Generally, I think this is good advice for people suffering from allergies, since the salty water flushes through the nasal cavity and nasopharynx where pollens and other allergens can adhere.  I prefer to use a plastic squeeze bottle rather than the traditional neti pot, since with the squeeze bottle you have the advantage of being able to force the saline through your sinuses and nasal passages with some pressure.  For colds, I find the nasal flush more useful towards the end of a stuffy-nosed cold – it’s really satisfying to see those deposits of snot getting flushed out.  In my experience, at the beginning of a stuffy-nosed cold, using the neti pot just makes me more stuffed up.  If you are new to the neti pot, have someone show you how to do it, or Google “neti pot” on the Internet – there are hundreds of people out there who are very excited to share the technique with you.

Cool Lady: Menopausal Hot Flash Formula

Ingredients:

Bie jia – 
Amyda sinensis turtle shell

Qing hao – 
Artemisia annua herb

Sheng di huang – 
Rehmannia glutinosa root (uncured)

Shu di huang – 
Rehmannia glutinosa root (cured)

Yin chai hu – 
Stellaria dichotoma root

Di gu pi – 
Lycium chinense bark

Han lian cao – 
Eclipta prostrata herb

Mu dan pi – 
Paeonia suffroticosa root bark

Zhi mu – 
Anemarrhena asphodeloides rhizome

Bai shao – 
Paeonia alba root

Water

Ethanol

Effects:

Eliminate or reduce perimenopausal and menopausal hot flashes and night sweats.  In Chinese medical terms, this formula primarily cools vacuity heat and secondarily nourishes the yin.  Cool Lady may also help with excessive menstrual bleeding, which is often due to too much “heat,” and there are herbs here that clear heat and stop bleeding.

Dosage:

Start with four full squirts of the dropper, twice a day.  This should eliminate or reduce your hot flashes quickly, within a matter of days.  If not, try more – five or six squirts.  Once you are feeling better, start reducing the twice-daily dose. Play around with the dosage, constantly trying to achieve your minimum effective dose.  After several weeks of being blissfully hot flash free, try weaning yourself completely and then use Cool Lady only on an as-needed basis.  I recommend thinning it down in a small glass of water, mostly because I personally can’t stand the taste of mu dan pi (tree peony root bark), which predominates.  Squirt the tincture into a cup of freshly boiled water to evaporate most of the alcohol if you wish to avoid alcohol. 

Background:

The Chinese talk a lot about yin and yang – you could say that it is the fundamental organizing principle behind all forms of classical Chinese culture, from painting to warfare to medicine.  In the human body, yin is the soft parts, the interior, the lower portion, and yang is the hard parts, the exterior, the upper portion.  Most importantly for our present purposes, yin is the watery, fluid aspect of ourselves – the ocean that we internalized when we crawled out of the sea many eons ago.  And yang is the fiery aspect – the flame of digestion, the heat of passion, the slow burn of life and growth.  Modern life is extremely yang: full force, relentless forward movement, constant stimulation and activity with too little time for the quintessential yin “activities” of sleep and rest.  The result is that we almost literally burn out, like soup that has been left on the fire too long.  Add to that the fact that both yin and yang naturally get depleted with age, and that women lose some of their yin on a monthly basis (blood is a subset of yin in the body), and you end up with a deficit of both – and for many women, a comparatively larger deficit of yin.  So, even though the yang fire is low, the yin water is even lower so the fire appears to flare.  This flaring, known as “yin vacuity fire,” can manifest as a hot flash.  What I love about this description of what’s going on in the body is that although it appears to be so poetic and metaphorical, it is actually extremely accurate and useful: the medicine that evolved from this way of thinking really works.  I would go so far as to say that this is why Chinese medicine truly shines when it comes to women’s health.  Yin-yang theory is an excellent basis for understanding much of nature, but it is especially good for diagnosing and treating women, who with their monthly cycles embody the ebb and flow of yin and yang, making them easier to treat.

Product Description:

This formula is a variation of Qing Hao Bie Jia Tang (“Artemisia and Turtle Shell Decoction”), first put down in writing in 1798 in a book on infectious disease.  The original formula was designed to treat injury to the yin in the wake of a febrile disease, with night fevers that recede in the morning.  My friend and teacher Andy Ellis first suggested to me years ago that I use it to treat hot flashes, saying it was stronger and more effective than most of the usual menopause formulas.  I’ve found him to be right!  And I am especially happy with this particular version, since it works so well.

The original formula consists of bie jia (turtle shell), qing hao (artemisia herb), sheng di huang (uncured rehmannia root), zhi mu (anemarrhena root), and mu dan pi (tree peony root bark).  The crux of this formula is the pairing of turtle shell, which is deeply yin-nourishing, with artemisia, which clears heat.  Note that this is Artemisia annua, the source of the sesquiterpene lactone artemisinin (widely used in combination malaria treatments and off-label as a cancer treatment), not the Artemisia absinthium that shows up in my home-made absinthe or the Artemisia vulgaris that I use for making moxa.  Although sheng di huang (uncured rehmannia root) and zhi mu (anemarrhena root) are considerd to be somewhat yin-nourishing, they are primarily heat-clearing herbs, as is mu dan pi (tree peony root bark), the remaining herb in the original formula.  Therefore, you can see that this formula is more about clearing the vacuity heat than it is about nourishing yin per se.

To make my version of this formula more yin-nourishing, I have added shu di huang (cured rehmannia root), which strongly nourishes the yin and the blood, and han lian cao (eclipta herb), which also tonifies the yin while at the same time clearing vacuity heat (eclipta also has the reputation, both in Chinese medicine and in Indian Ayurveda, of turning grey hair black again).  Additionally, the herbs di gu pi (lycium bark) and yin chai hu (stellaria root) are included for their specific effect of clearing yin vacuity heat.  Finally, a small amount of bai shao (peony root) is included to “preserve the yin.”  Bai shao has an astringency that hold the yin in and helps prevent night sweats.  It is also a major blood-tonifying herb that regulates the menses and smoothes the qi and blood in conditions such as abdominal pain, cramps, and all-around yuckiness-feeling.  Bai shao is one of my favorite herbs.

It is not uncommon for women to experience excessive menstrual bleeding during the transition to menopause.  This is because, as it heats up, the blood turns "reckless" and overflows.  Fortunately, many of the herbs here help stop menstrual bleeding: sheng di huang, mu dan pi, di gu pi, han lian cao, yin chai hu, and bai shao all help in some way to regulate and stop menstrual bleeding.  For this reason, this formula can be very useful not just for perimenopausal and menopausal women, but for any woman who experiences heavy periods due to heat in the blood.  It is possible to suffer from menorrhagia due to other causes, so if you are experiencing heavy menstrual bleeding with no hot flashes or other menopausal symptoms, you should get checked out by a practitioner of Chinese medicine to determine the cause of your heavy bleeding.  Or you can try some Cool Lady and, if it works, conclude that you have some sort of blood heat or yin vacuity heat going on.

Production Notes:

2.5 liters of an alcohol-water blend was slowly percolated through one kilogram of pre-moistened ground-up herbs to produce about 2 liters of tincture.  A second percolation of 500 ml. boiling water was performed to better extract the more water-soluble yin-nourishing herb constituents, and the resulting fluid was added to the main tincture.  Strength of the final tincture is 1:2.5. 

I can’t help but put in a plug here for Spring Wind Herbs, the source for most of the dried bulk herbs that go into my tinctures (and owned and run by the aforementioned Andy Ellis).  A lot of bulk Chinese herbs out there are in pretty sorry shape.  Not only is misidentification and mislabeling of herbs a problem in the industry; even if the herb is the correct plant, there’s a lot of dusty musty stuff out there whose colors and aromas are indistinct and which has probably sat in a warehouse for months, being nibbled on by rats and bugs.  Not so Spring Wind Herbs!  Opening the sealed plastic bags of Spring Wind herbs is a feast for the senses.  The qing hao in this formula is the freshest, most vibrant qing hao I’ve ever seen: so green, so fragrant!  And the mu dan pi, also so strongly aromatic (if yuckily so).  The sheng di huang and shu di huang are notoriously difficult to grind, so I was extremely pleased to be able to get them pre-ground to a fine powder (how do they do it? first freeze-dry, then grind?).  Thank you Spring Wind!

Other Considerations:

You shouldn’t rely exclusively on Cool Lady to nourish your yin and clear your heat.  Stop being so yang’d out.  Slow down.  Rest more.  Spend time communing with earth and ocean.  Incorporate more yin-nourishing foods into your diet, like seaweeds (wakame, kombu, hijiki), leafy greens, mung beans, oysters, fish, mushrooms.  Drink enough water.  Cut down on, or eliminate, things that burn the yin, like alcohol, cigarettes, and spicy fried foods.  Because Cool Lady is more heat-clearing than yin-nourishing, you may find that it gets rid of your hot flashes, but when you stop taking it the hot flashes come back.  If you follow the dosage recommendations above and find that your hot flashes return after you have weaned yourself from the herbs, you should take a more straightforwardly yin-nourishing formula such as Liu Wei Di Huang Tang (available in most natural food stores in pill form) in conjunction with Cool Lady.  Take the Liu Wei Di Huang Tang regularly and long-term, adding Cool Lady at low dose or as needed.  Cool Lady is not meant to be used long-term, as the preponderance of cooling herbs may dampen the digestive fire and end up causing loose stools or diarrhea.  If your digestion is weak to begin with, try smaller doses and take them after meals rather than before.  If this doesn’t work for you, let me know, and we can discuss herbal strategies for protecting the digestion while concurrently nourishing yin and clearing vacuity heat.

Anti-Inflammatory Blend: Natural Relief for Chronic Pain

Ingredients:

Yan hu suo – 
Corydalis yanhusuo rhizome

Hu zhang – 
Polygonum cuspidatum root/rhizome

Dan shen – 
Salvia miltiorrhiza root

Ji xue teng – 
Millettia dielsiana root and vine

Dang gui – 
Angelica sinensis root

Chuan xiong – 
Ligusticum wallichii root

Sang ji sheng – 
Viscum album stems

Wei ling xian – 
Clematis chinensis root

Sheng gan cao – 
Glycyrrhiza uralensis root

Yarrow – 
Achillea millefolium (fresh-tinctured)

Ethanol

Water

Effects:

Reduce pain and inflammation after traumatic injury and in chronic pain conditions like osteoarthritis, fibromyalgia and chronic regional pain syndrome, and autoimmune diseases such as lupus and rheumatoid arthritis.  People suffering from menstrual cramps, abdominal masses, heart pain, or chronic headaches may also benefit, though they should probably see a practitioner for a customized herb formula.

Dosage:

Four full squirts of the dropper, twice a day.  I recommend thinning it down in a small glass of water.  If you wish to avoid alcohol, you can squirt the tincture into a cup of freshly boiled water to evaporate most of the alcohol.  I suggest taking it before breakfast and before dinner, to get the herbs into your bloodstream without competition from food (although, if the herbs make your stomach feel funny, take them after a meal rather than before).  I also suggest starting out with a small dose (one full squirt), and increasing to two squirts, three squirts, and finally four squirts over the course of a week or two.  Though I list the standard dose as four squirts twice a day, you should experiment and establish for yourself your own personal minimum effective dose, and stick to that.  Keep in mind that these are herbs, not drugs, and you should not expect an instant analgesic effect as you would with Advil or morphine.  Rather, stay consistent with your twice-daily doses and expect results in a week or two.  Finally, I don’t recommend taking anything (aside from food and some food-like herbs) all the time, forever.  It’s good to show the body what is possible, then encourage it to achieve that on its own.  So, when you start to notice a decrease in pain and inflammation, take advantage of your improved condition to start walking again, or going to your restorative yoga class, and then take a break from the herbs.  If the pain comes back you can start with the herbs again.

Cautions and Contraindications:

This formula should not be used if you are pregnant or think you may be pregnant.  Also, I would not recommend this formula if you are already on coumadin or other blood-thinners.  Aside from that, my opinion is that this formula is quite safe.  When taking any substance into the body, there is always a risk of some idiosyncratic adverse effect or undesirable interaction with something else you are taking.  On the one hand, this leads many physicians to be unnecessarily conservative about their patients mixing herbs with medications, and this prevents the patient from getting the optimum results that could be had.  On the other hand, there are definitely herbs that affect the metabolism of drugs in the body, leading to an overdose of whatever drugs you are on (if the herb inhibits the metabolic enzymes that should be hacking the drug apart in your liver at a predictable rate) or an underdose (if the herb promotes the enzyme and it dissembles your medication before it can do any good).  As far as I know, no comprehensive survey of Chinese herbs has been done as far as their effects on metabolic enzymes goes.  Since the typical herb formula contains eight or more herbs, there is always the risk that some herb in there will affect an enzyme and mess with your drug metabolism.  For this reason I typically don’t prescribe herbs while a patient is undergoing chemotherapy – I want the chemo to do its job and would feel horrible if my herbs made chemo ineffective or unnecessarily toxic for my patient.  Please note that this formula contains at least two herbs – corydalis yanhusuo and salvia miltiorrhiza – that may inhibit cytochrome P450, a family of key metabolic enzymes.  So, if you are taking any medications and are concerned about potential herb-drug interactions, you should not take this formula.  However, in addition to this formula providing its own pain-relieving and anti-inflammatory effects, its inhibition of cytochrome P450 means that you may be able to lower the dosage of whatever drug you are taking to achieve the same effect it was having at a higher dose.  If you are the adventurous sort and have an open-minded doctor with whom you could keep close tabs on your blood chemistry and state of health, the combination of this formula and whatever else you are taking could be a productive foray into integrative medicine that could potentially result in weaning you from what becomes an unnecessary prescription medication.  Finally, don't discount the possibility that a prescription drug that you are on is causing your pain in the first place. Countless medications, among them such common drugs as Lipitor, Premarin, and Xanax, cause joint pain in certain percentages of patients.  If it's medically feasible, and with the collusion of your doctor, try taking a break from a drug you're on and see if your pain goes away.

Background:

To understand this formula, we need to appreciate the Chinese medical understanding of pain.  There is a famous saying in acupuncture that asserts, “Where there is free flow there is no pain.  Where there is pain, there is no free flow.”  “Free flow” refers to the flow of qi (energy) and blood through the channels of the body.  What impedes this free flow?  Anything from injury, to inactivity, to improper body mechanics, to stress, to genetic and pathogenic factors can cause the stagnation that leads to pain.  Many Chinese formulas for the treatment of pain focus on pathogenic factors such as wind, dampness, heat, and cold.  I prefer to focus on resolving the stagnation of qi and especially of blood, since all chronic pain has a strong qi and blood stagnation factor, regardless of its ultimate origin.

Product Description:

The two main herbs are yan hu suo (corydalis) and hu zhang (polygonum cuspidatum or Japanese knotweed).  The corydalis is energetically “warm” and the knotweed is “cold,” so together they create a balanced formula that is able to treat hot conditions exhibiting redness and swelling (think rheumatoid arthritis) as well as cold conditions (like osteoarthritis that gets worse in cold weather).  Corydalis is a genus of about 470 species in the Fumariaceae family, sometimes treated as a subfamily of the Papaveraceae, whose star performer is the opium poppy.  Given this family resemblance, it is not surprising that our corydalis exhibits pain-killing properties.  Yet, the analgesia induced by corydalis is not due to opioids; rather, it contains other alkaloids such as corydaline and tetrahydropalmatine whose combined efficacy (according to my trusty Chinese Herbal Medicine Materia Medica by Bensky and Gamble, 1993 edition) is about 40% that of morphine.  If that is true, this is some significant pain-killing action indeed.  The other main herb, Japanese knotweed, is not one of the most popular herbs used in traditional Chinese medicine, where it shows up in formulas for inhibited menstrual flow, certain types of jaundice, liver cancer, cough, and skin infections.  But in Japanese folk medicine, it reigns supreme as a treatment for pain of all sorts.  In fact, its Japanese name – itadori – literally means “pain remover.”  This herb has become a major commercial source of resveratrol, the substance in red wine that has been much-researched for its effects on life extension with purported anti-cancer, anti-inflammatory, blood sugar lowering, and other beneficial effects.  It also contains emodin, which is a laxative, so if you find that this formula makes you go poop more than you like, you’ll know why and you can lower the dose.

Most of the other herbs also fall in the blood-moving category and contribute to the pain-reducing effects of the main herbs.  Chinese angelica, millettia, and sang ji sheng (mistletoe that is parasitic on mulberry) are blood tonics as well as blood movers – which is to say, they build and nourish the blood in addition to moving it.  Dan shen (red sage root) is a wonderful herb that is excellent for resolving blood stasis generally, but deserves special mention for its ability to treat chest pain.  When my mother developed angina some years ago, I put her on a formula in which dan shen was the main herb, and it helped to control her symptoms.  The only herb here that is not a blood mover is wei ling xian (clematis root).  It falls in the category of herbs that dispel wind-dampness, and I include it here because it is a great herb for joint pain of all kinds.

Finally, there is one fresh herb in the mix, and that is yarrow.  Yarrow is one of my favorite plants.  It has been used in Europe since ancient times as an effective digestive, fever-reducer, and blood-stauncher.  It is not a major herb in Chinese medicine, though the Chinese recognize its above-listed traits and, depending on the source, also praise its ability to relieve pain, regulate menstruation, and resolve heat and toxin (treat boils and abscesses and other infections).  Traditionally the whole above-ground plant is used, but lately I’ve been making a fresh tincture from just the deep green feathery leaves, on a hunch that yarrow’s pain- and inflammation-relieving virtues reside there.  Yarrow is one source for the brilliant blue chemical azulene, which is known to be a potent anti-inflammatory (I think, but am not sure, that azulene is only produced at high heat during steam distillation, though I believe that its precursor chamazulene is extracted during maceration and contributes to yarrow’s anti-inflammatory effect).  The yarrow in this particular batch of Anti-Inflammatory Blend is particularly magical, since half of it was picked at dawn on the winter solstice by my daughter Sara and me, after a memorable all-night sweat lodge (the other half was picked at the height of summer).  I think of yarrow as having a “clearing” effect that includes a clearing of whatever is gumming up the channels and blood vessels.  From a Chinese medical standpoint, I think that in addition to being blood-moving and improving the circulation per se, yarrow (along with the clematis) also “pushes” pathogenic factors out of the channels and collaterals.  It is this same spicy pushiness that makes yarrow effective in resolving fevers.  Although it is only about one-tenth of the formula, yarrow’s soapy-bitter flavor (along with dang gui’s pungent celery-ness) predominates, which makes me think of it as an especially strong player in the “team” that comprises this formula.  As an aside, I believe that yarrow is an aphrodisiac for ladybugs.  Over the years I have observed, both in the garden and in the wild, that ladybugs love this plant and can often be found on it in pairs, humping their little hearts out!  What significance this holds for humans, if any, I cannot say.

Production Notes:

Three liters of an alcohol-water blend was slowly percolated through one kilogram of pre-moistened ground-up herbs to produce 2.5 liters of tincture.  To this was added 300 ml. of fresh yarrow tincture, made with 95% pure ethanol.  Estimated strength of final tincture is between 1:2 and 1:3. 

Other Considerations in the Treatment of Pain:

In traditional Chinese medicine, acupuncture is generally used as an adjunct treatment for most diseases – by needling points at the surface of the body, we believe that we can affect the goings-on deep within the body.  For most illnesses, herbal medicine is usually the primary treatment, since the herbs actually go deep into the organs, where they are needed, to do their work.  But for the treatment of pain, especially musculoskeletal pain, acupuncture should be the primary treatment.  This is because most pain conditions are lodged in the connective tissue, and that is where the acupuncture needles go to free up the restrictions that accompany most pain patterns.  Whether you think of these restrictions as myofascial trigger points or stagnation of qi and blood in the channels, acupuncture is uniquely qualified to directly treat these impediments to free flow. Massage, gua sha (scraping), cupping, and moxibustion can also be very helpful in the treatment of pain conditions.

But acupuncture, massage, etc. are relatively passive processes.  You just lie there while somebody manipulates your body.  You get up feeling better, and then launch right back into ways of moving and living that bring the pain back.  Many pain conditions involve lifestyle components like posture and gait, and level and nature of activity.  Posture and gait are two of the main contributors to osteoarthritis, and they are quite difficult to correct on your own.  If you suspect that your pain is at least partially a result of the way you hold your body and move it in space as you go about your daily life, you may want to consider a series of sessions with a physical therapist, occupational therapist, or practitioner of Feldenkrais or other movement education therapies.  Often, not just how we hold ourselves but what we actually physically do or don’t do with our bodies ends up causing pain.  If you are getting carpal tunnel syndrome or some other pain associated with sitting at a computer, you should look into ergonomic considerations like chair height, computer monitor position, keyboard and mouse shape, etc.  And take more breaks!  If your lifestyle is somewhat sedentary, make the decision to exercise more.  Build it into your routine: go for a half-hour walk every morning, or a bike ride, or whatever.  If that sounds excessive, make it every other day, or even once a week for starters – the body recognizes and responds to regularity and consistency in any form.  I recommend yoga as a great system of building strength as well as flexibility.  But be careful: I have seen many injuries (including my own!) from yoga done over-enthusiastically.  Best to start with a super-mellow beginner’s class, or better yet a class specifically designed for people with pain and mobility issues. If you are in too much pain to exercise, first do a course of Anti-Inflammatory Blend and acupuncture/massage/Feldenkrais, then start exercising as these therapies make the pain more manageable.  A water exercise class is a great way to reintroduce movement into your life if other forms of exercise are too challenging.  If you suffer from chronic pain, regular exercise will help you feel better.

Finally, I should mention more conventional approaches to the treatment of pain.  Starting with the least potentially harmful: Advil (ibuprofen) is, in my opinion, a wonder drug for musculoskeletal pain.  If my back goes out, or a rib, I immediately pop four Advils and keep doing that twice a day for two to three days.  I have found that during those first couple days it is best to just lay low and not try too hard to fix things.  On day three or so I will have my kids administer scraping and cupping and some acupuncture.  In the meantime, Advil is the ticket!  It’s usually the first recommendation of most doctors as well, for most pain.  I am not so comfortable with Advil for long-term pain management.  There are real issues of liver toxicity and deterioration of the stomach lining, and I don’t like the thought of being dependent on a chemical that, although it reduces pain, isn’t really good for you.  So, for chronic pain I prefer the methods outlined in this article.

Next is cortisone.  Cortisone, along with adrenaline, is a glucocorticoid – one of the main hormones released by the body in response to stress.  During the course of human evolution, it really helped to have an amazing endogenous anti-inflammatory kick in instantly when a boulder crushed your leg or a wildcat chomped off your hand.  Similarly, a cortisone injection can provide immediate relief for the pain of a rotator cuff injury or other non-healing lesion.  Cortisone should not be discounted if you are in a lot of pain and other therapies haven’t helped.  But repeated cortisone treatments is not a good idea because of several negative side effects.  Cortisone reduces inflammation quite miraculously, but it also depresses the immune system, diminishes tissue integrity, and can lead to conditions such as osteoporosis, diabetes, and glaucoma.  Not recommended for long-term use.

Opioid drugs such as hydrocodone and morphine control pain very effectively, but this relief can come at quite a cost.  First of all, your central nervous system is affected and you aren’t quite yourself when under their influence.  Second, they depress vital functions such as digestive system motility (leading to constipation) and breathing (in the best cases leading to cough suppression when it is needed, but in the worst case to death from respiratory failure).  Most significantly, it is very easy to get addicted to these substances.  “Legal heroin” is not an inaccurate phrase.  You start out following the doctor’s dosage recommendation, and you are amazed at how much better you feel.  But, over time, your body gets used to that dosage and your pain returns, so you take just a little bit more to get relief.  And so on, until you are addicted, and when you realize this and try to wean yourself, that’s when you feel really crappy and want to get back on it so that you don’t feel so damn miserable.  Not recommended except for emergencies and end-of-life pain relief.

Finally, there is surgery.  Unfortunately, surgery is a real crapshoot.  It may make you feel way better.  It may fuck you up really bad.  It’s possible, even likely, that you will never regain full range of motion in the body part that was operated on.  If you end up with a condition where the doctors are recommending surgery, you owe it to yourself to do a lot of homework, research the statistics on recovery and success rates, and get second and third opinions before making a decision.  If you do decide to have surgery, be prepared for a long recuperation, and to put in a lot of work.  If you do your physical therapy, take your herbs and supplements, do acupuncture, do the movement therapies, stay tuned in to your body and keep pushing it to its maximum ability to heal, there is a good chance that you will have a favorable outcome, that you will have your body back and be out of pain.

Concluding Remarks

Clearly, pain is a vast and complex subject that includes everything from hormonal imbalances to physical structural anomalies to psycho-emotional factors to existential considerations.  As the Buddha so perceptively remarked 2,500 years ago, “Life is suffering.”  It would be unrealistic to claim that Green Monkey Pharmacy’s Anti-Inflammatory Blend can eliminate all pain.  But this is a good formula that I’ve been getting good results with in the year or so that I’ve been experimenting with it.  I’d be very interested in getting your reports on how it’s working for you.  If it’s not working as well as you’d like as a stand-alone treatment, please consider some of the recommendations I’ve made in this article.


Addendum 4-27-12:
Some weeks ago I was hanging out with UCSC chemistry professor Ted Holman. The focus of Ted's research is lipoxygenase inhibition. Lipoxygenase is a family of enzymes whose job is to break down fats in the body. Because some of the breakdown products of fats are heavy-duty pro-inflammatories, the hope is that by selectively inhibiting lipoxygenases, we will be able to reduce inflammation in the body. When I mentioned to Ted that I had just created an anti-inflammatory herb formula, he offered to test it in his lab. The results were quite conclusive: a very small amount of the tincture (only 10 microliters) completely inhibited 5-lipoxygenase! We don't know what component of what herb in the formula is so strongly LOX-inhibiting, and there may well be other anti-inflammatory mechanisms at work, but still, it was very gratifying to get some objective data supporting the effectiveness of the formula.

Jade Defense: the "Herbal Flu Shot"

Ingredients:

Huang qi - 
Astragalus membranaceus root

Wu jia shen - 
Eleutherococcus senticocus root

Bai zhu - 
Atractylodes macrocephala rhizome

Fang feng - 
Ledebouriella divaricata root

California Spikenard -
Aralia californica root (fresh-tinctured)

Ethanol

Water

Effects:

Decrease in frequency and severity of colds and flu; strengthened immune response; increased energy; better digestion; regulation of stress response via hypothalamic-pituitary-adrenal axis.  You may find that immune-related chronic conditions like asthma and allergies, and even certain types of aches and pains, improve.

Dosage:

Three full squirts of the dropper, twice a day.  You can squirt the tincture directly into your mouth if you don’t mind the alcohol or the taste (personally, I like the flavor, mildly sweet and balsamic).  If you prefer, you can squirt it into a cup of freshly boiled water to evaporate most of the alcohol.  This will not diminish the therapeutic effect.  I suggest taking it before breakfast and before dinner, to get the herbs into your bloodstream without competition from food.  I also suggest starting out with a small dose (one full squirt), and increasing to two squirts and finally three squirts over the course of a week.  This will give your body a chance to get to know the herbs.  Everybody is different, and some people need far less of a formula than other people.  So if you felt great at two squirts  and not so great at three squirts, listen to your body – two squirts may be the perfect dose for you.  Note that this is a tonic formula that gradually strengthens your immune system over time.  Don’t be discouraged if you catch a cold early on in your Jade Defense regimen.  Just take a break from the herbs while you are sick, then start again once you are well.  This is not a formula to treat colds and flu (such a formula is in the works) but to prevent them.  I suggest taking it consistently for at least a month, and preferably through the fall and winter.  One two-ounce bottle is enough for two weeks at the full recommended dose.

Product Description:

A glance at the ingredients list for this formula will show that there is not even a fleck of jade in it.  And visual inspection will quickly determine that the color of this particular elixir is a cloudy brown, not a beautiful green.  So where does the name “Jade Defense” come from?  The original formula, consisting of the three herbs huang qi (astragalus), bai zhu (atractylodes), and fang feng (ledebouriella), was already ancient when the famous Chinese physician Zhu Danxi wrote it down about 700 years ago.  Because the formula had gained renown for its usefulness in fending off wind (i.e., colds and flu), it was given the name Yu Ping Feng San, or Jade Screen (for) Wind Powder.  Because jade in Chinese culture has since the earliest times been ascribed a near-supernatural power to protect, bless, and prolong life, the fact that it was given this name, and that it is to this day one of the most popular Chinese herbal formulas, tells us something of its value.

The original formula is very unusual in that it consists of only three herbs.  Chinese herbal medicine has evolved as a system of polypharmacy, in which herbs are used together in “teams” to maximize synergistic effects and prevent or reduce side effects. In Jade Wind-Screen Powder, the astragalus is considered to be the chief herb.  It strongly boosts the qi (vital energy) and stabilizes the exterior.  To switch briefly from ancient Chinese metaphors to Star Trek, astragalus “turns the deflector shields on.”  Atractylodes is considered the deputy herb.  It strengthens the effects of the chief herb, and whereas astragalus is said to tonify the lungs and spleen, atractylodes more directly strengthens the spleen. (Note: in Chinese medicine, “spleen” is shorthand for the digestive process, so a spleen tonic optimizes the process by which the body extracts energy and nutrients from the food that we eat).  Ledebouriella root is the assistant herb.  It usually shows up in formulas that actually treat colds, as well as in formulas to treat pain.  Once the astagalus and the atractylodes have strengthened the vital energy, ledebouriella circulates it near the surface of the body to form a protective layer that wards off pathogens.

From a biomedical perspective, astragalus and atractylodes are adapatogenic herbs that regulate the immune system.  Astragalus is an extensively researched herb, and its polysaccharides, glycosides, and triterpenoids have been shown to increase interferon production and stimulate macrophages.  Atractylodes has similarly been shown to promote phagocytosis and antibody production and also exhibits hypoglycemic effects.  Ledebouriella is broadly antimicrobial, showing inhibitory effects against some influenza viruses as well as Shigella, Pseudomonas, and Staphylococcus bacteria species.

To the original formula, I have added two additional herbs: eleutherococcus senticosus (“Siberian ginseng”), and aralia californica (California Spikenard).  Eleutherococcus, also known as acanthopanax, is mostly prescribed in Chinese medicine for muscle pains and swelling, for which the root bark is most effective.  The whole root has been the object of much study by the Russians and Koreans, who use it as a general tonic to improve endurance, immunity, and memory, and to decrease pain.  Though I find the reports of its use among cosmonauts and Olympic athletes intriguing, what really convinced me of eleutherococcus’ usefulness over the years has been the varied accounts from all kinds of people who told me personally that it “just made them feel better.”  I believe that it synergizes with astragalus to provide a stronger immune-boosting and stress-relieving effect.

The second additional herb, California Spikenard, was picked at one of my favorite spots near the base of a waterfall in remote Big Sur.  Plants that grow in extreme environments tend to be higher in active components than plants growing in blander climes.  And let me tell you, this plant comes from a wild place!  In the winter storms it is thrashed and submerged by rushing torrents that fling entire redwood trees around like toothpicks.  Three years ago the Basin Fire raged around it, burning trees to black husks and unleashing a wave of erosion that permanently altered the contours of its narrow ravine home.  Yet, despite fire and water and tons of sand and rock, this stand of aralia is thriving.  It took me the better part of an hour to dig up the thick aromatic roots that over many years curled their way around large stones.  The root, looking like a large mandrake or a ginseng, fairly cries out “I am good medicine!”  I chopped and moistened it with pure alcohol the day it was picked, then blended it the next day and did a percolation with additional alcohol.  This plant, like the eleutheroccus, comes from the family Araliaceae, which is rich in medicinal plants – Asian ginseng (Panax ginseng), American ginseng (Panax quinquefolius), Devil’s Club (Oplopanax horridus) of the American Northwest, the excellent Chinese blood herb san qi (Panax pseudoginseng) are all in this family.  And, like its relatives, it too demonstrates immune-enhancing effects.  But, more so than most of its cousins, aralia has a direct antitussive and expectorant effect on the lungs.  I suspect this is due to its distinctive sticky oleoresin, which the body excretes at least partially through the lung lining.  Like other aromatic medicinal resins (redwood and osha spring to mind), its outgassing into the alveoli serves a stimulating and disinfecting purpose in the primate who ingests it, encouraging throat and bronchial secretions, treating cough and (in this case proactively) viral infections, and generally promoting the health of the lungs.  It is the dissolved oleoresin that makes this tincture slightly cloudy – the oleoresin was well-dissolved in pure alcohol but is less well “carried” by the water-alcohol mix that was used to extract the remainder of the formula, so the mixture creates a a “louche” or microemulsion much like absinthe or ouzo does when it is mixed with water.

As you can tell, I’m pretty jazzed about this aralia.  I think of it as the “secret weapon” of this formula.  Also, generally speaking, I like to include at least one fresh-extracted local herb in most of my formulas.  They “brighten” the formula, much like a fresh salad or salsa adds a splash of pizzazz to a cooked meal. Despite the relatively small amount of aralia in this formula, it is definitely the dominant flavor note.

Production Notes:

1.5 kilograms of ground-up herbs produced 3.5 liters of tincture.  To this was added about 500 ml. of fresh aralia tincture, starting mass and water content of the fresh root unknown.  Estimated strength of final tincture is about 1:2.  The first kilogram of herbs was extracted by percolation after moistening for 48 hours in a mixture of water (60%) and alcohol (40%).   The same ratio of solvents, chosen to maximize polysaccharide extraction, was used for the percolation.  The resulting tincture was refluxed over low heat in the Soxhlet Extractor so that a second extraction was achieved.  Preferring the taste of the no-heat first extraction to that of the low-heat second extraction, I performed a second percolation of another 500 grams of freshly-ground herbs and added it to the original tincture, with no second wash-through.  Finally, the fresh aralia tincture was added, particulate matter in the final formula was allowed to settle, and then the formula was bottled.

Other Things You Can Do To Stimulate the Immune System:

Moxibustion:  The burning of mugwort fuzz, or “moxa,” is a healing art in its own right.  In Western Japan where I was born, there are moxibustionists who treat all manner of illness entirely by burning small cones of moxa at strategic acupuncture points.  Naturally, doing it the traditional hardcore way (burning the cones all the way down to the skin) hurts!  I suspect that the administration of micro-burns causes the immune system to launch a retaliation to this perceived assault at the body’s periphery, and that increased immunity to viruses and other pathogens is a kind of side-effect of this self-repair and self-protection mechanism.  If you are interested, I can burn you or show you how to burn yourself safely at home.  There is also a less hardcore method in which you let the cone burn just until you feel the burn, at which point you yank or flick the cone off.  This sort of penetrating heat therapy is actually quite pleasant once you can relax and get over the fear of getting burned.

Steam:  Although I knew theoretically that steam inhalation could attenuate or kill viruses, I never really gave this method a fair shake.  That is, until my friend, the immunologist Martha Zuniga, explained to me in detail the scientific basis for this method and convinced me to buy a home steamer.  For $35 I purchased one of these devices at CVS (produced by a company called Kaz [!], since taken over by Vicks), and steam for 15 minutes whenever I feel like I might be coming down with something.  It works like a charm!  The key is to strike early, and to repeat once more over the course of the next 24 hours.  I have stopped colds in their tracks using this method, and even when I was too late to truly nip it in the bud, the steaming seems to make the cold lose its oomph and peter out faster than it otherwise would.

Other:  Needless to say, eating healthy whole foods, getting plenty of sleep, exercising regularly, etc., are the most important factors in staying healthy so that your immune system can work like it’s supposed to.

Enter the Green Monkey

There is a phrase in Japanese storytelling – ima wa mukashi – that means, “Now is the ancient past.”  The storyteller says this first to set the stage for the story to follow, letting us know that it took place a long time ago.  It also puts the audience into the story, into the ancient past, so they can experience the story from within, as a participant rather than as a passive listener.  It’s a handy-dandy neurolinguistic programming device, a kind of a time machine.  So:

Ima wa mukashi.  The monkeys are agitated.  The weather is changing.  The forest is shrinking.  Strange bugs are swarming, fruit aren’t ripening at their usual times, many monkeys are sick, and quite a few are dying.  The monkey bands flee the pestilence and chaos of their home, heading out into the unfamiliar savannah.  One monkey, himself sick and weakened, limps along with his group.  When the rest of the group stops for the night, huddled together for warmth and protection, this monkey leaves his starving companions, heading for a nearby hill, drawn inexplicably to the bump in the landscape. Ominous black clouds are forming overhead, it starts to drizzle, then pour, but the monkey stays his course.  Lightning pierces the darkness, thunder explodes, and the wind shrieks.  A thunderbolt strikes the hillside and a fire erupts.  The monkey, as if in a trance, continues on.  Every now and then, he stops and picks some of the foliage around him, nibbles on a few of the green bitter leaves, and holds onto bunches of leaves to eat later.  When he gets to the hillside, the fire has subsided, though there are still smoldering spots here and there.  The monkey spies a young antelope, crushed under a tree.  He notices that the animal is singed and blackened from the fire.  He sniffs the air.  It smells good.  He tears off a forelimb and takes a nibble.  He begins to gorge.  His belly full, the monkey takes a nap.  When he wakes up, he is feeling better, though still feverish.  He sees the antelope’s skull, broken open with the brains sizzling inside.  Inspired, he stuffs into the skull the leaves he has gathered previously.  Soon the brew is bubbling away.  Eventually the fire subsides and the skull is cool enough to grab.  The monkey slurps down his creation.  It is slightly bitter, but delicious.  Over the next day or two, his fever subsides.  The monkey starts back towards his band, a new lightness in his step and confidence shining from his eyes, a smoldering stick in one hand, bunches of herbs in the other.  He chews on fresh leaves all the way home.  His band sees him coming.  They think he is crazy, waving the burning stick and bunches of leaves in the air.  But, as he nears, they are amazed at how healthy he appears.  There is much hooting and hollering as he rejoins the group, and the monkeys gaze in wonder at their companion’s strange-looking, green-stained lips and teeth.  The Green Monkey gets to work, starting a fire, cooking the magic leaves, serving his friends and relatives.  Soon the band is healthy, ready to face the future, whatever it may hold.

Of course, I have packed into one simian superhero a number of epic events that actually must have occurred over many generations of early hominids: the taming of fire, the advent of cooking, the usage of medicinal herbs. It cannot be denied that cooking is something that sets us apart from other animals.  Cooking, by concentrating nutrients and in a sense “predigesting” our food, frees us up from the pretty much constant foraging that the eating of raw foods demands.  In the abundant free time thus created, humanity emerged and flourished.  (The definitive work on this theme is Catching Fire: How Cooking Made Us Human by Harvard anthropologist Richard Wrangham).  As for medicinal herbs, it’s true that other animals use herbs in the wild to treat their illnesses.  In fact, many of the origin stories of medicinal herbs have to do with people observing sick or injured animals eating certain herbs and then getting better.  But a couple of things set human herbal medicine apart from animal herbal medicine.  First, cooking and other methods of extraction allow us to ingest herbal medicines in concentrated form without having to eat piles of hard-to-digest leaves and hard-to-chew roots.  And second, with the invention of writing, we have been able to catalog an encyclopedic database of herbal knowledge that is transmitted from generation to generation in books and living traditions of clinical practice.

It may have occurred to the astute reader that our current situation is not unlike that of the monkeys at the beginning of our story.  The climate is changing, new diseases are emerging, the monkeys are agitated.  Ima wa mukashi, indeed.  I believe that it is extremely important for humanity to tap into the vast pharmacopeia of nature to help us deal with our health problems.  It’s great that government-funded natural products chemists are scouring our jungles and oceans for compounds that will fight cancer and other ills.  But it is equally important to utilize existing knowledge of herbal traditions, especially because effective treatments for some of our most common health complaints have already been discovered.  This is where Green Monkey Pharmacy comes in.  I don’t claim to have the cure for cancer.  But, with my training in traditional Chinese medicine and extensive experience in medicine-making, I am pleased to offer you high-quality herbal medicines that will fill many of your healthcare needs.